Healthcare Provider Details

I. General information

NPI: 1992242945
Provider Name (Legal Business Name): APRIL MOODY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 11/22/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E. MAIN AVE.
AVA MO
65608
US

IV. Provider business mailing address

504 E BROADWAY AVE
AVA MO
65608-5670
US

V. Phone/Fax

Practice location:
  • Phone: 417-251-2107
  • Fax:
Mailing address:
  • Phone: 417-251-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802089208
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: